Masui. The Japanese journal of anesthesiology
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We experienced a case of the abortive malignant hyperthermia (MH) that had developed during operation. The patient was a 14-year-old girl, and plastic surgery was scheduled under general anesthesia. Serum creatine kinase (CK) levels were high with 505 IU x l(-1) at the preoperative examination. ⋯ As sevoflurane, promotes the CICR (calcium-induced calcium release) mechanism, the trigger of this case is probably sevoflurane. As for the symptom that makes us doubt MH first, there is a maked rapid rises of Et(CO2). Therefore, it is important monitor and recognize the first symptom of MH.
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Pentax AWS Airway Scope (Pentax, Japan) is a new videolaryngoscope. We successfully used the device in 15 patients and in other two patients with difficult airways. In a 51-year-old woman, after induction of anesthesia and neuromuscular blockade, laryngoscopy using a Macintosh blade showed only the tip of the epiglottis and tracheal intubation failed. ⋯ At laryngoscopy using a Macintosh blade, the epiglottis was long and tubular, and tracheal intubation failed. With the Airway Scope, the trachea was intubated easily. We believe that the Pentax AWS videolaryngoscope is useful in patients with and without difficult airways.
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Mulvihill-Smith syndrome is a rare disease that belongs to progeroid syndromes. This syndrome is characterized by a senile face with an underdeveloped lower half, short stature, microcephaly, multiple pigmented nevi, immunodeficiency, hearing loss, and high-pitched voice. We report anesthetic management of a 27-year-old woman, 138 cm and 27 kg, with this syndrome, who underwent removal of mandibular cyst, partial resection of tongue and keratoplasty. ⋯ The changes of blood pressure during anesthesia were extraordinary, suggesting the presence of advanced arteriosclerosis. The postoperative course was uneventful, with stable hemodynamics, and the patient was discharged from the hospital on 9th postoperative day. Anesthesia for Mulvihill-Smith syndrome should be performed with caution for the potential risk of difficult airway and unstable hemodynamics.
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New era in the prevention of venous thromboembolism (VTE) in Japan started in 2004 when the Japanese guideline for prevention of VTE was released by the editorial committee on the Japanese guideline for prevention of VTE and Japanese public health system began to cover the cost of physical prevention of VTE for hospitalized patients. The incidence of perioperative symptomatic pulmonary thromboembolism (PTE) significantly decreased in 2004 compared with 2003 and 2002 according to the results of the annual research for perioperative PTE by the Japanese Society of Anesthesiologists (3.62/10,000 cases in 2004, 4.41/10,000 cases in 2002, 4.76/10,000 cases in 2003). However, there has been no change in the mortality rate of perioperative PTE during these three years. This special issue was planned to introduce the panel discussion titled as "Up-to-date medical care for perioperative venous thromboembolism in Japan-Standardization of care for perioperative venous thromboembolism in Japan" in the 53rd annual scientific meeting of the Japanese Society of Anesthesiologists at Kobe in 2006.
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Three pregnant women with diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), received emergency cesarean section in our hospital. Considering low platelet counts, in all three patients, operations were performed under general anesthesia using sevoflurane without epidural or spinal anesthesia. Special attention was paid to management of blood pressure, especially intra-operative hypertension. ⋯ Complications of this syndrome were severe including acute renal failure, DIC, pulmonary edema, cerebral hemorrhage and liver rupture. It is reported that maternal mortality is 2-24%. In the management of pregnant women complicated with HELLP syndrome, early diagnosis and adequate therapy, including preventive therapy for complications, are necessary.